Brugada pattern masquerading as ST-segment elevation myocardial infarction in flecainide toxicity
Lovely Chhabra1, David H Spodick
1Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA 01608, USA. lovids@hotmail.com
Indian Heart Journal
|August 30, 2012
Summary
Flecainide toxicity can cause a rare Brugada pattern on ECGs in elderly patients. This ECG change, mimicking myocardial infarction, requires clinical expertise for accurate diagnosis.
Area of Science:
- Cardiology
- Clinical Toxicology
- Pharmacology
Background:
- Flecainide, a Class 1C antiarrhythmic, slows intracardiac conduction.
- Common ECG effects include prolonged PR, QT intervals, and QRS duration.
- Brugada pattern is a rare but serious ECG finding.
Observation:
- An elderly female patient on therapeutic flecainide developed a Type 1 Brugada pattern.
- Her prior ECGs on flecainide showed normal patterns.
- This presentation occurred during a suspected flecainide toxicity episode.
Findings:
- Flecainide toxicity can induce a Type 1 Brugada pattern.
- This ECG abnormality can be mistaken for ST-elevation myocardial infarction (STEMI).
- High clinical suspicion and expertise are crucial for correct interpretation.
Implications:
- Recognizing flecainide-induced Brugada pattern is vital to avoid misdiagnosis of acute coronary syndrome.
- This case highlights the importance of considering drug toxicity in ECG abnormalities.
- Alerts clinicians to a rare but critical adverse effect of flecainide therapy.
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